Skip to main content
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging 7/2011

01.07.2011 | Original Article

Parametric images via dynamic 18F-fluorodeoxyglucose positron emission tomographic data acquisition in predicting midterm outcome of liver metastases secondary to gastrointestinal stromal tumours

verfasst von: Dimitris J. Apostolopoulos, Antonia Dimitrakopoulou-Strauss, Peter Hohenberger, Safwan Roumia, Ludwig G. Strauss

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 7/2011

Einloggen, um Zugang zu erhalten

Abstract

Purpose

18F-Fluorodeoxyglucose positron emission tomography (FDG PET) may underestimate viable tumour tissue in patients with gastrointestinal stromal tumours (GIST) treated with molecular targeted agents. The aim of the present study was to investigate the value of parametric images generated after dynamic data acquisition for the detection of active liver metastases.

Methods

The analysis included 65 dynamic FDG PET studies in 34 patients with liver metastases from GIST who were treated with imatinib or sunitinib. Parametric images of intercept and slope were calculated by dedicated software using a voxel-based linear regression of time-activity data. Intercept images represent the tracer’s distribution volume and the slope its overall metabolic turnover. All images were assessed visually and semi-quantitatively. Liver disease status was established 12 months after each PET study. Dichotomous variables of visual interpretation and various quantitative parameters were entered in a statistical model of linear discriminant analysis.

Results

Visual analysis of slope images was more sensitive than the standard 1-h FDG uptake evaluation (70.6 vs 51.0%, p = 0.016) in detecting cases with liver disease progression (n = 51). Specificity did not differ. Combination of all variables in the discriminant analysis model correctly classified 87.7% of cases as progressive or non-progressive disease. Sensitivity was raised to 88.2%.

Conclusion

Parametric images of intercept and slope add a new dimension to the interpretation of FDG PET studies, by isolating visually and quantifying the perfusion and phosphorylation-dependent part of tracer uptake. In treated GIST patients, integration of this information with the 1-h uptake data achieves better characterization of hepatic lesions with respect to disease activity.
Literatur
1.
Zurück zum Zitat Benjamin RS, Debiec-Rychter M, Le Cesne A, Sleijfer S, Demetri GD, Joensuu H, et al. Gastrointestinal stromal tumours II: medical oncology and tumour response assessment. Semin Oncol 2009;36:302–11.PubMedCrossRef Benjamin RS, Debiec-Rychter M, Le Cesne A, Sleijfer S, Demetri GD, Joensuu H, et al. Gastrointestinal stromal tumours II: medical oncology and tumour response assessment. Semin Oncol 2009;36:302–11.PubMedCrossRef
2.
Zurück zum Zitat Blanke CD, Demetri GD, von Mehren M, Heinrich MC, Eisenberg B, Fletcher JA, et al. Long-term results from a randomized phase II trial of standard- versus higher-dose imatinib mesylate for patients with unresectable or metastatic gastrointestinal stromal tumors expressing KIT. J Clin Oncol 2008;26:620–5.PubMedCrossRef Blanke CD, Demetri GD, von Mehren M, Heinrich MC, Eisenberg B, Fletcher JA, et al. Long-term results from a randomized phase II trial of standard- versus higher-dose imatinib mesylate for patients with unresectable or metastatic gastrointestinal stromal tumors expressing KIT. J Clin Oncol 2008;26:620–5.PubMedCrossRef
3.
Zurück zum Zitat Gold JS, van der Zwan SM, Gönen M, Maki RG, Singer S, Brennan MF, et al. Outcome of metastatic GIST in the era before tyrosine kinase inhibitors. Ann Surg Oncol 2007;14:134–42.PubMedCrossRef Gold JS, van der Zwan SM, Gönen M, Maki RG, Singer S, Brennan MF, et al. Outcome of metastatic GIST in the era before tyrosine kinase inhibitors. Ann Surg Oncol 2007;14:134–42.PubMedCrossRef
4.
Zurück zum Zitat Duensing S, Duensing A. Targeted therapies of gastrointestinal stromal tumors (GIST)—the next frontiers. Biochem Pharmacol 2010;80:575–83.PubMedCrossRef Duensing S, Duensing A. Targeted therapies of gastrointestinal stromal tumors (GIST)—the next frontiers. Biochem Pharmacol 2010;80:575–83.PubMedCrossRef
5.
Zurück zum Zitat Van den Abbeele AD. The lessons of GIST—PET and PET/CT: a new paradigm for imaging. Oncologist 2008;13 Suppl 2:8–13.PubMedCrossRef Van den Abbeele AD. The lessons of GIST—PET and PET/CT: a new paradigm for imaging. Oncologist 2008;13 Suppl 2:8–13.PubMedCrossRef
6.
Zurück zum Zitat Prior JO, Montemurro M, Orcurto MV, Michielin O, Luthi F, Benhattar J, et al. Early prediction of response to sunitinib after imatinib failure by 18F-fluorodeoxyglucose positron emission tomography in patients with gastrointestinal stromal tumor. J Clin Oncol 2009;27:439–45.PubMedCrossRef Prior JO, Montemurro M, Orcurto MV, Michielin O, Luthi F, Benhattar J, et al. Early prediction of response to sunitinib after imatinib failure by 18F-fluorodeoxyglucose positron emission tomography in patients with gastrointestinal stromal tumor. J Clin Oncol 2009;27:439–45.PubMedCrossRef
7.
Zurück zum Zitat Mabille M, Vanel D, Albiter M, Le Cesne A, Bonvalot S, Le Péchoux C, et al. Follow-up of hepatic and peritoneal metastases of gastrointestinal tumors (GIST) under imatinib therapy requires different criteria of radiological evaluation (size is not everything!!!). Eur J Radiol 2009;69:204–8.PubMedCrossRef Mabille M, Vanel D, Albiter M, Le Cesne A, Bonvalot S, Le Péchoux C, et al. Follow-up of hepatic and peritoneal metastases of gastrointestinal tumors (GIST) under imatinib therapy requires different criteria of radiological evaluation (size is not everything!!!). Eur J Radiol 2009;69:204–8.PubMedCrossRef
8.
Zurück zum Zitat Goerres GW, Stupp R, Barghouth G, Hany TF, Pestalozzi B, Dizendorf E, et al. The value of PET, CT and in-line PET/CT in patients with gastrointestinal stromal tumours: long-term outcome of treatment with imatinib mesylate. Eur J Nucl Med Mol Imaging 2005;32:153–62.PubMedCrossRef Goerres GW, Stupp R, Barghouth G, Hany TF, Pestalozzi B, Dizendorf E, et al. The value of PET, CT and in-line PET/CT in patients with gastrointestinal stromal tumours: long-term outcome of treatment with imatinib mesylate. Eur J Nucl Med Mol Imaging 2005;32:153–62.PubMedCrossRef
9.
Zurück zum Zitat Stroobants S, Goeminne J, Seegers M, Dimitrijevic S, Dupont P, Nuyts J, et al. 18FDG-Positron emission tomography for the early prediction of response in advanced soft tissue sarcoma treated with imatinib mesylate (Glivec). Eur J Cancer 2003;39:2012–20.PubMedCrossRef Stroobants S, Goeminne J, Seegers M, Dimitrijevic S, Dupont P, Nuyts J, et al. 18FDG-Positron emission tomography for the early prediction of response in advanced soft tissue sarcoma treated with imatinib mesylate (Glivec). Eur J Cancer 2003;39:2012–20.PubMedCrossRef
10.
Zurück zum Zitat Choi H, Charnsangavej C, de Castro Faria S, Tamm EP, Benjamin RS, Johnson MM, et al. CT evaluation of the response of gastrointestinal stromal tumors after imatinib mesylate treatment: a quantitative analysis correlated with FDG PET findings. AJR Am J Roentgenol 2004;183:1619–28.PubMed Choi H, Charnsangavej C, de Castro Faria S, Tamm EP, Benjamin RS, Johnson MM, et al. CT evaluation of the response of gastrointestinal stromal tumors after imatinib mesylate treatment: a quantitative analysis correlated with FDG PET findings. AJR Am J Roentgenol 2004;183:1619–28.PubMed
11.
Zurück zum Zitat Scaife CL, Hunt KK, Patel SR, Benjamin RS, Burgess MA, Chen LL, et al. Is there a role for surgery in patients with “unresectable” cKIT+ gastrointestinal stromal tumors treated with imatinib mesylate? Am J Surg 2003;186:665–9.PubMedCrossRef Scaife CL, Hunt KK, Patel SR, Benjamin RS, Burgess MA, Chen LL, et al. Is there a role for surgery in patients with “unresectable” cKIT+ gastrointestinal stromal tumors treated with imatinib mesylate? Am J Surg 2003;186:665–9.PubMedCrossRef
12.
Zurück zum Zitat Sokoloff L. Mapping local functional activity by measurement of local cerebral glucose utilization in the central nervous system of animals and man. Harvey Lect 1983–1984;79:77–143. Sokoloff L. Mapping local functional activity by measurement of local cerebral glucose utilization in the central nervous system of animals and man. Harvey Lect 1983–1984;79:77–143.
13.
Zurück zum Zitat Patlak CS, Blasberg RG. Graphical evaluation of blood-to-brain transfer constants from multiple-time uptake data. Generalizations. J Cereb Blood Flow Metab 1985;5:584–90.PubMedCrossRef Patlak CS, Blasberg RG. Graphical evaluation of blood-to-brain transfer constants from multiple-time uptake data. Generalizations. J Cereb Blood Flow Metab 1985;5:584–90.PubMedCrossRef
14.
Zurück zum Zitat Burger C, Buck A. Requirements and implementation of a flexible kinetic modeling tool. J Nucl Med 1997;38:1818–23.PubMed Burger C, Buck A. Requirements and implementation of a flexible kinetic modeling tool. J Nucl Med 1997;38:1818–23.PubMed
15.
Zurück zum Zitat Schmidt KC, Turkheimer FE. Kinetic modeling in positron emission tomography. Q J Nucl Med 2002;46:70–85.PubMed Schmidt KC, Turkheimer FE. Kinetic modeling in positron emission tomography. Q J Nucl Med 2002;46:70–85.PubMed
16.
Zurück zum Zitat Dimitrakopoulou-Strauss A, Hoffmann M, Bergner R, Uppenkamp M, Eisenhut M, Pan L, et al. Prediction of short-term survival in patients with advanced nonsmall cell lung cancer following chemotherapy based on 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography: a feasibility study. Mol Imaging Biol 2007;9:308–17.PubMedCrossRef Dimitrakopoulou-Strauss A, Hoffmann M, Bergner R, Uppenkamp M, Eisenhut M, Pan L, et al. Prediction of short-term survival in patients with advanced nonsmall cell lung cancer following chemotherapy based on 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography: a feasibility study. Mol Imaging Biol 2007;9:308–17.PubMedCrossRef
17.
Zurück zum Zitat Dimitrakopoulou-Strauss A, Pan L, Strauss LG. Parametric imaging: a promising approach for the evaluation of dynamic PET-18F-FDG studies—the DKFZ experience. Hell J Nucl Med 2010;13:18–22.PubMed Dimitrakopoulou-Strauss A, Pan L, Strauss LG. Parametric imaging: a promising approach for the evaluation of dynamic PET-18F-FDG studies—the DKFZ experience. Hell J Nucl Med 2010;13:18–22.PubMed
18.
Zurück zum Zitat Messa C, Choi Y, Hoh CK, Jacobs EL, Glaspy JA, Rege S, et al. Quantification of glucose utilization in liver metastases: parametric imaging of FDG uptake with PET. J Comput Assist Tomogr 1992;16:684–9.PubMedCrossRef Messa C, Choi Y, Hoh CK, Jacobs EL, Glaspy JA, Rege S, et al. Quantification of glucose utilization in liver metastases: parametric imaging of FDG uptake with PET. J Comput Assist Tomogr 1992;16:684–9.PubMedCrossRef
19.
Zurück zum Zitat Afifi A, Clark VA, May S. Computer-aided multivariate analysis. 4th ed. Boca Raton: Chapman & Hall/CRC; 2004. Afifi A, Clark VA, May S. Computer-aided multivariate analysis. 4th ed. Boca Raton: Chapman & Hall/CRC; 2004.
20.
Zurück zum Zitat Tan MC, Linehan DC, Hawkins WG, Siegel BA, Strasberg SM. Chemotherapy-induced normalization of FDG uptake by colorectal liver metastases does not usually indicate complete pathologic response. J Gastrointest Surg 2007;11:1112–9.PubMedCrossRef Tan MC, Linehan DC, Hawkins WG, Siegel BA, Strasberg SM. Chemotherapy-induced normalization of FDG uptake by colorectal liver metastases does not usually indicate complete pathologic response. J Gastrointest Surg 2007;11:1112–9.PubMedCrossRef
21.
Zurück zum Zitat Lubezky N, Metser U, Geva R, Nakache R, Shmueli E, Klausner JM, et al. The role and limitations of 18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan and computerized tomography (CT) in restaging patients with hepatic colorectal metastases following neoadjuvant chemotherapy: comparison with operative and pathological findings. J Gastrointest Surg 2007;11:472–8.PubMedCrossRef Lubezky N, Metser U, Geva R, Nakache R, Shmueli E, Klausner JM, et al. The role and limitations of 18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan and computerized tomography (CT) in restaging patients with hepatic colorectal metastases following neoadjuvant chemotherapy: comparison with operative and pathological findings. J Gastrointest Surg 2007;11:472–8.PubMedCrossRef
22.
Zurück zum Zitat Strauss LG, Dimitrakopoulou-Strauss A. Can PET-CT with FDG replace contrast enhanced CT for imaging of liver metastases? Eur J Nucl Med Mol Imaging 2007;34:1902–5.PubMedCrossRef Strauss LG, Dimitrakopoulou-Strauss A. Can PET-CT with FDG replace contrast enhanced CT for imaging of liver metastases? Eur J Nucl Med Mol Imaging 2007;34:1902–5.PubMedCrossRef
23.
Zurück zum Zitat Bipat S, van Leeuwen MS, Comans EF, Pijl ME, Bossuyt PM, Zwinderman AH, et al. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis–meta-analysis. Radiology 2005;237:123–31.PubMedCrossRef Bipat S, van Leeuwen MS, Comans EF, Pijl ME, Bossuyt PM, Zwinderman AH, et al. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis–meta-analysis. Radiology 2005;237:123–31.PubMedCrossRef
24.
Zurück zum Zitat Gronchi A, Fiore M, Miselli F, Lagonigro MS, Coco P, Messina A, et al. Surgery of residual disease following molecular-targeted therapy with imatinib mesylate in advanced/metastatic GIST. Ann Surg 2007;245:341–6.PubMedCrossRef Gronchi A, Fiore M, Miselli F, Lagonigro MS, Coco P, Messina A, et al. Surgery of residual disease following molecular-targeted therapy with imatinib mesylate in advanced/metastatic GIST. Ann Surg 2007;245:341–6.PubMedCrossRef
25.
Zurück zum Zitat Wardelmann E, Thomas N, Merkelbach-Bruse S, Pauls K, Speidel N, Büttner R, et al. Acquired resistance to imatinib in gastrointestinal stromal tumours caused by multiple KIT mutations. Lancet Oncol 2005;6:249–51.PubMedCrossRef Wardelmann E, Thomas N, Merkelbach-Bruse S, Pauls K, Speidel N, Büttner R, et al. Acquired resistance to imatinib in gastrointestinal stromal tumours caused by multiple KIT mutations. Lancet Oncol 2005;6:249–51.PubMedCrossRef
26.
Zurück zum Zitat Ye YJ, Gao ZD, Poston GJ, Wang S. Diagnosis and multi-disciplinary management of hepatic metastases from gastrointestinal stromal tumour (GIST). Eur J Surg Oncol 2009;35:787–92.PubMed Ye YJ, Gao ZD, Poston GJ, Wang S. Diagnosis and multi-disciplinary management of hepatic metastases from gastrointestinal stromal tumour (GIST). Eur J Surg Oncol 2009;35:787–92.PubMed
27.
Zurück zum Zitat Prenen H, Stefan C, Landuyt B, Vermaelen P, Debiec-Rychter M, Bollen M, et al. Imatinib mesylate inhibits glucose uptake in gastrointestinal stromal tumor cells by downregulation of the glucose transporters recruitment to the plasma membrane. Am J Biochem Biotechnol 2005;1:95–102.CrossRef Prenen H, Stefan C, Landuyt B, Vermaelen P, Debiec-Rychter M, Bollen M, et al. Imatinib mesylate inhibits glucose uptake in gastrointestinal stromal tumor cells by downregulation of the glucose transporters recruitment to the plasma membrane. Am J Biochem Biotechnol 2005;1:95–102.CrossRef
28.
Zurück zum Zitat Klawitter J, Anderson N, Klawitter J, Christians U, Leibfritz D, Eckhardt SG, et al. Time-dependent effects of imatinib in human leukaemia cells: a kinetic NMR-profiling study. Br J Cancer 2009;100:923–31.PubMedCrossRef Klawitter J, Anderson N, Klawitter J, Christians U, Leibfritz D, Eckhardt SG, et al. Time-dependent effects of imatinib in human leukaemia cells: a kinetic NMR-profiling study. Br J Cancer 2009;100:923–31.PubMedCrossRef
29.
Zurück zum Zitat Shankar S, vanSonnenberg E, Desai J, DiPiro PJ, Van Den Abbeele A, Demetri GD. Gastrointestinal stromal tumor: new nodule-within-a-mass pattern of recurrence after partial response to imatinib mesylate. Radiology 2005;235:892–8.PubMedCrossRef Shankar S, vanSonnenberg E, Desai J, DiPiro PJ, Van Den Abbeele A, Demetri GD. Gastrointestinal stromal tumor: new nodule-within-a-mass pattern of recurrence after partial response to imatinib mesylate. Radiology 2005;235:892–8.PubMedCrossRef
30.
Zurück zum Zitat Lammertsma AA, Hoekstra CJ, Giaccone G, Hoekstra OS. How should we analyse FDG PET studies for monitoring tumour response? Eur J Nucl Med Mol Imaging 2006;33 Suppl 1:16–21.PubMedCrossRef Lammertsma AA, Hoekstra CJ, Giaccone G, Hoekstra OS. How should we analyse FDG PET studies for monitoring tumour response? Eur J Nucl Med Mol Imaging 2006;33 Suppl 1:16–21.PubMedCrossRef
31.
Zurück zum Zitat Torizuka T, Nobezawa S, Momiki S, Kasamatsu N, Kanno T, Yoshikawa E, et al. Short dynamic FDG-PET imaging protocol for patients with lung cancer. Eur J Nucl Med 2000;27:1538–42.PubMedCrossRef Torizuka T, Nobezawa S, Momiki S, Kasamatsu N, Kanno T, Yoshikawa E, et al. Short dynamic FDG-PET imaging protocol for patients with lung cancer. Eur J Nucl Med 2000;27:1538–42.PubMedCrossRef
32.
Zurück zum Zitat Strauss LG, Dimitrakopoulou-Strauss A, Haberkorn U. Shortened PET data acquisition protocol for the quantification of 18F-FDG kinetics. J Nucl Med 2003;44:1933–9.PubMed Strauss LG, Dimitrakopoulou-Strauss A, Haberkorn U. Shortened PET data acquisition protocol for the quantification of 18F-FDG kinetics. J Nucl Med 2003;44:1933–9.PubMed
33.
Zurück zum Zitat Nitzsche EU, Hoegerle S, Mix M, Brink I, Otte A, Moser E, et al. Non-invasive differentiation of pancreatic lesions: is analysis of FDG kinetics superior to semiquantitative uptake value analysis? Eur J Nucl Med Mol Imaging 2002;29:237–42.PubMedCrossRef Nitzsche EU, Hoegerle S, Mix M, Brink I, Otte A, Moser E, et al. Non-invasive differentiation of pancreatic lesions: is analysis of FDG kinetics superior to semiquantitative uptake value analysis? Eur J Nucl Med Mol Imaging 2002;29:237–42.PubMedCrossRef
34.
Zurück zum Zitat Dimitrakopoulou-Strauss A, Strauss LG, Heichel T, Wu H, Burger C, Bernd L, et al. The role of quantitative (18)F-FDG PET studies for the differentiation of malignant and benign bone lesions. J Nucl Med 2002;43:510–8.PubMed Dimitrakopoulou-Strauss A, Strauss LG, Heichel T, Wu H, Burger C, Bernd L, et al. The role of quantitative (18)F-FDG PET studies for the differentiation of malignant and benign bone lesions. J Nucl Med 2002;43:510–8.PubMed
35.
Zurück zum Zitat Doot RK, Dunnwald LK, Schubert EK, Muzi M, Peterson LM, Kinahan PE, et al. Dynamic and static approaches to quantifying 18F-FDG uptake for measuring cancer response to therapy, including the effect of granulocyte CSF. J Nucl Med 2007;48:920–5.PubMedCrossRef Doot RK, Dunnwald LK, Schubert EK, Muzi M, Peterson LM, Kinahan PE, et al. Dynamic and static approaches to quantifying 18F-FDG uptake for measuring cancer response to therapy, including the effect of granulocyte CSF. J Nucl Med 2007;48:920–5.PubMedCrossRef
36.
Zurück zum Zitat Strauss LG, Koczan D, Klippel S, Pan L, Cheng C, Willis S, et al. Impact of angiogenesis-related gene expression on the tracer kinetics of 18F-FDG in colorectal tumors. J Nucl Med 2008;49:1238–44.PubMedCrossRef Strauss LG, Koczan D, Klippel S, Pan L, Cheng C, Willis S, et al. Impact of angiogenesis-related gene expression on the tracer kinetics of 18F-FDG in colorectal tumors. J Nucl Med 2008;49:1238–44.PubMedCrossRef
37.
Zurück zum Zitat Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med 2009;50 Suppl 1:122S–50.PubMedCrossRef Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med 2009;50 Suppl 1:122S–50.PubMedCrossRef
Metadaten
Titel
Parametric images via dynamic 18F-fluorodeoxyglucose positron emission tomographic data acquisition in predicting midterm outcome of liver metastases secondary to gastrointestinal stromal tumours
verfasst von
Dimitris J. Apostolopoulos
Antonia Dimitrakopoulou-Strauss
Peter Hohenberger
Safwan Roumia
Ludwig G. Strauss
Publikationsdatum
01.07.2011
Verlag
Springer-Verlag
Erschienen in
European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 7/2011
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-011-1776-2

Weitere Artikel der Ausgabe 7/2011

European Journal of Nuclear Medicine and Molecular Imaging 7/2011 Zur Ausgabe